Brockmann Jens G, Senninger Norbert, Wolters Heiner H
Klinik und Poliklinik für Allgemeine Chirurgie, Universitätsklinikum Münster, Walderyerstrasse 1, 48149 Münster, Germany.
Langenbecks Arch Surg. 2007 May;392(3):219-25. doi: 10.1007/s00423-007-0162-9. Epub 2007 Mar 21.
Living donor nephrectomy (LDN) has evolved a variety of different surgical techniques. Minimal invasive strategies were introduced to benefit the healthy donors. This paper attempts to identify the best possible practise in live kidney donation with special respect to donor safety.
We present a single-centre experience of 173 live kidney donations and describe the surgical technique of open retroperitoneal donation in detail and by video sequences. Additionally, the evidence for donor safety (mortality and morbidity) and the integrity of the graft function are reviewed, comparing different surgical techniques for LDN.
Focussing on maximal donor safety, a retroperitoneal access seems mandatory. Very detailed informed consent, including the offer for different retrieval techniques, has led to a total of 163 open and 10 hand-assisted retroperitoneal live kidney donations at our institution. Published and own data reveal longer operating and warm ischaemic times for minimal invasive kidney removal when compared with open technique. Adequate perioperative analgesia (peridural catheter) provides comparable patient comfort, duration of hospital stay, complications and graft function although there are some procedure-associated risks for minimal invasive techniques.
The special ethical situation of live donation necessitates maximal donor safety. Although open antero-lateral incision and retroperitoneal access does provide some inconveniences for the surgeon, we are convinced that this and the hand-assisted retroperitoneal approach are the only two options for LDN.
活体供肾肾切除术（LDN）已发展出多种不同的手术技术。为使健康供体受益，引入了微创策略。本文旨在确定活体肾捐赠中最佳的可行做法，特别关注供体安全。
我们介绍了单中心173例活体肾捐赠的经验，并通过视频序列详细描述了开放式腹膜后捐赠的手术技术。此外，回顾了供体安全（死亡率和发病率）及移植肾功能完整性的证据，比较了LDN的不同手术技术。
着眼于最大程度的供体安全，腹膜后入路似乎必不可少。非常详细的知情同意，包括提供不同的取肾技术，已使我们机构共进行了163例开放式和10例手辅助腹膜后活体肾捐赠。已发表的数据和我们自己的数据显示，与开放技术相比，微创取肾的手术时间和热缺血时间更长。尽管微创技术存在一些与手术相关的风险，但充分的围手术期镇痛（硬膜外导管）可提供相当的患者舒适度、住院时间、并发症及移植肾功能。
活体捐赠的特殊伦理情况要求最大程度的供体安全。尽管开放式前外侧切口和腹膜后入路对外科医生来说确实存在一些不便，但我们坚信这和手辅助腹膜后入路是LDN仅有的两种选择。
